Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Abstract

The impact of parathyroidectomy (PTX) on the long-term risks for hip and other fractures is unknown. Uncontrolled case series have reported an increase in bone mineral density after PTX. However, very low serum parathyroid hormone levels have been associated with decreased bone mineral density, adynamic bone disease, and fractures. This study compared long-term fracture rates among hemodialysis patients who underwent PTX with a matched control group. Data were obtained from the US Renal Data System. Patients who underwent a first PTX while receiving hemodialysis were matched with up to three control patients by age, race, gender, year of dialysis initiation, primary cause of renal failure, and the dosage of intravenous vitamin D used before PTX. Patients with a history of fracture or renal transplantation were excluded. Study outcomes were incident hip, vertebral, and distal radius-wrist fractures identified using hospitalization codes. Incident hip fracture rates in the PTX and matched control groups were 6.0 and 9.3 fractures per 1000 person-years, respectively. After adjustment, PTX was associated with a significant 32% lower risk for hip fracture (95% confidence interval 0.54 to 0.86; P ϭ 0.001) and a 31% lower risk for any analyzed fracture (95% confidence interval 0.57 to 0.83; P Ͻ 0.001) compared with matched control subjects. Fracture risks were lower among hemodialysis patients who underwent PTX compared with matched control subjects. Surgical amelioration of secondary hyperparathyroidism may outweigh the risk of parathyroid hormone oversuppression in terms of bone health.

Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis

“…The reduction in clinical fractures observed with cinacalcet treatment in this study was similar to that observed in a case control study of surgical parathyroidectomy in the United States that demonstrated a 32% reduction in subsequent hip fractures. 31 The importance of PTH as a biomarker of abnormal bone is controversial. 32,33 Cohort studies have shown an increased risk of fracture associated with low PTH 12,29,30 or very high PTH.…”

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

“…Moreover, left ventricular function in patients with advanced sHPT and dilated cardiomyopathy was markedly improved by PTx. 40 Other possible mechanisms for post-PTx survival improvement include reduction in fracture risk; 41 improvement in anemia and hypertension, 42 cardiac autonomic nervous system, 43 life-threatening condition of calciphylaxis, 44 immune system, 45 muscle strength, 46 as well as sustained reduction in fibroblast growth factor 23.…”

Parathyroidectomy in Hemodialysis Patients

“…KMD'deki iyileşme genellikle postoperatif 1.aydan itibaren başlamaktadır. Rudsder ve ark.nın çalışmasında paratiroidektomi yapılan hastalarda herhangi bir kırık ve kalça kalça kemiği kırığı riskinde anlamlı azalma gözlenmiştir (23). Mortalite riski açısından da önemli çalışmalar bulunmaktadır.…”